Renal fractional excretion of sodium in relation to arterial blood gas and spirometric parameters in chronic obstructive pulmonary disease

Introduction: Arterial gas derangement could change urinary sodium excretion in Chronic Obstructive Pulmonary Disease [COPD] patients. There are very few and conflicting data in regards to the measurement of fractional excretion of sodium in COPD patients. The main aim of this study was to assess the relationship between renal fractional excretion of sodium [FeNa] with arterial blood gas and spirometric parameters in COPD

Materials and Methods: This study was a cross-sectional study performed on 40 consecutive stable COPD outpatients in 2 main general hospitals [Emam Reza, Ghaem] in Mashhad/Iran between 2011 and 2012. We investigated the relationship of renal FeNa with arterial blood gas parameters including HCO3, PH, PaCO2 and PaO2, and spirometric parameters. Analysis was done by SPSS v16 with a statistically meaningful p value of less than 0.05

Results: Mean age was 65.97 +/- 10.77 SD years and female to male ratio was 0.26. A renal FeNa of less than 1% was presented in 27% patients. There was a significant, positive relationship between renal FeNa and PaO2 [P=0.005, r=0.456]. The correlations between PaCO2, HCO3, PH and spirometric parameters were not seen [P>0.05], but there was a significant relationship between Urine Na and PaO2. Outstanding, it seems likely that kidneys of COPD patients are responsible for sodium retaining state particularly in the presence of hypoxemia

Conclusion: This study indicates that in COPD patients, PaO2 but not PaCO2 is related to renal FeNa which shows the probable role of hypoxemia on sodium output in COPD patients. However, some caution is needed for interpretation of the probable role of hypercapnia on sodium retention in COPD

[ evaluation of dialysis adequacy by KTN in hemodialysis patients]

Patients with ESRD need adequate dialysis. According to DOQI guidelines, minimum dialysis dose by KT/V in patients under hemodialysis [HD] is 1.2 or greater. In a cross- sectional study, we evaluated the value of KT/V among HD patients in shahid Beheshti Hospital of Abadan, Iran. HD was performed for 3 to 4 hours, using synthetic dialyzer and the bicarbonate- based dialysate. Blood flow rate, dialysate flow rate and ultrafiltration rate were 250 to 300 cc /min, 500cc/min and zero or 1 to 3 liters, respectively. Blood sampling for BUN was done immediately before and after the dialysis session. We used the following equation to estimate the KT/V from the percent reduction in urea [PRU]. KT/V = [0.026 xPRU] - 0.460 54 HD patients [28 females and 26 males] with the mean age of 39 +/- 14.2 years were enrolled in the study. The most common cause of ESRD was hypertension [24.07%] followed by, unknown [22.22%], DM [18.51%], Chronic Glomerulonephritis [14.81%], urinary tract abstraction [12.96%] and poly cystic kidney disease [7.40%]. KT/V was less than 1.2 in 87.03 patients [n=47]. There was no significant difference in the valve of KT/V in men and women [P= 0.54] and in different hemoglobin concentration [p=0.58]. The results of the study show that the most of our HD patients have not received minimum dialysis dose and we should evaluate and correct its causes

[Prevalence of low mineral bone density in renal transplant recipients one year or more after transplantation]

Reduction in mineral bone density is a common complication following kidney transplantation and its adverse outcome could be minimized with well recognition and treatment. In this study we evaluated the prevalence of mineral bone density decrease in kidney recipients at least one year after the transplantation. Kidney recipients from whom transplant surgery at least a year had assed and had a good kidney function were selected. Mineral bone densitometry using X- ray energy absorptiometry was performed. The serum levels of Ca, P, Alkaline Phosphatase and Paratormone were measured and the collected data were statistically analyzed. Overall 182 patients were studied. The total rate of mineral bone density decrease was 87.4%. Osteopenia in the femoral bone was 73.6% and osteoporosis was 13.8%. In the lumbar vertebrae an osteopenia of 66.5% and an osteoporosis of 20.9% were noticed. Variance of analysis showed that there were no statistically significant differences between duration of dialysis before kidney transplantation [P=0.777, P=0.420], duration of kidney transplantation [P=0.927, 0.271], the mean of serum PTH [P=0.908, P=0.146] and calcium [P=0.348, P=0.265] in respect to densitometry of femoral bone and lumbar vertebrae. The frequency of mineral bone density reduction one year after kidney transplant in patients with a good transplanted kidney function was high

[Comparison and evaluation of proteinuria in 8-and 24 hour urine samples in patients with diabetic nephropathy]

Diabetic nephropathy is the most important disease which often results in renal failure. Proteinuria is an important parameter which predicts progression of diabetic nephropathy. Gold standard method for protein measuring is collecting 24 hour urine. Instead of that, in several studies around the world, measuring level of urine protein in 24 hours of the day has been carried out. In this study, we intended to specify the relation between quantitative amount of 8 hour and 24 hour urine protein in patients with diabetic nephropathy. The study population included 50 patients with diabetic nephropathy before ESRD We obtained the following samples: 1] 8-h urine, and 2] 24-h urine. We measured serum creatinine concentration, creatinine clearance, urine volume, urinary protein and creatinine concentration. Our statistic method of analysis was Pierson's correlation method. Age mean was 53 +/- 14 years old and diabetes duration mean was 13 +/- 4.10 years. The mean of nocturnal 8hr urine protein and 24 hr one were 24.20 +/- 42, 33.35 +/- 43, 71.26 +/- 84 mg, respectively. There was a direct significant correlation between 8hr and 24hr urine protein [r=0.8, p=0.001]. A significant correlation was also detected between nocturnal 8hr urine protein and daily one with 24hr urine protein. There was a significant and direct relationship between 8hr urine protein [daily and nightly] and 24hr urine protein. This might be used for urine protein collection in patients with diabetic nephropathy to improve the compliance

Serum triiodothyronine level as an indicator of inflammation in patients undergoing dialysis

It has been shown that inflammation affects thyroid function. In patients with end-stage renal disease, low plasma triiodothyronine [T3] may be an unsuspected expression of the inflammatory state of these patients. This study evaluated the correlation between T3 and high-sensitivity C-reactive protein [HSCRP] levels in patients on peritoneal dialysis [PD] and hemodialysis. This is a cross-sectional study aiming at the correlation between T3 and HSCRP levels among 30 patients on PD, 30 patients on hemodialysis, and 20 healthy individuals. Serum levels of HSCRP, T3, thyroxine [T4], thyroid stimulating hormone, T3 resin uptake, and free T3 index [FT3I] and free T4 index [FT4I] were compared between the three groups. There were no significant differences between hemodialysis and PD patients in respect to T3, T4, FT3I, and FT4I. In PD and hemodialysis patients, T3 and FT3I were lower than in controls [P < .001], but there was no significant difference between PD and hemodialysis patients. T3 resin uptake and thyroid stimulating hormone differed significantly between PD and hemodialysis patients. There was a significant inverse correlation between HSCRP and T3 and FT3I among hemodialysis patients [P = .04]; however, there was no such correlations in PD patients. The relationship between T3 and HSCRP suggests that inflammation might be involved in the low T3 syndrome in hemodialysis patients, but we did not find a significant correlation between T3 and HSCRP levels in patients on peritoneal dialysis

[Comparison of temporary dialysis catheter and A-V fistula use at the time of starting chronic hemodialysis among end-stage renal diseases patients]

The preferred type of access for chronic hemodialysis [HD] is an Arterio-Venous [A-V] Fistula. However most of the ESRD patients does not have a mature fistula at the time of starting HD due to late referral to the nephrologists so the managing physicians have to use temporary catheters with high rate of complications. In a retrospective study we determined and compared the prevalence of temporary catheters or A-VFistula use at the time of starting chronic HD from November 1995 to June 2009. We have divided our patients in three different groups. Group A: HD patients between 1995-2005, Group B: HD patients between 2006-2007, and Group C: HD patients after 2007. A total of 473 ESRD patients [288 male, 185 female; mean age, 55.8 +/- 16.4 years] were included in the study. Causes of ESRD were HTN 34.1%, DM 20. 08%, glomeronephritis 9.72%, obstructive uropathy 8.46%, ADPKD 5.92%, and unknown 21.77%. Overall the prevalence of temporary catheters and A-V Fistula use were 86.5 and 13.5 percent. But the prevalence was different in the studied groups: group A [93.6% and 6.4%], in group B [85.0% and 15.0%] and in group C [67.5% and 29. 5%] respectively. There was a significant increase in A-V Fistula use after 2005 [p=0.00] and especially after 2007 [p=0.000]. Although there was a significant increment in the A-V Fistula use, it is not still enough and general physicians, nurses and chronic kidney disease patients have to be educated about the benefits of early A-V Fistula creation

[Comparison of quality of life between hemodialysis and peritoneal dialysis patients in Imam Reza and Ghaem hospital dialysis centers in Mashhad]

Relative differences in QOL between hemodialysis [HD] and peritoneal dialysis [PD] are not clearly known. The objective of this study was to compare QOL between HD and PD patients in Emam Reza and Ghaem hospital dialysis centers. We compared 40 patients [17male and23 female] on PD with 40 matched patients [20 male and 20 female] on HD. Health related 36 item short form questionnaire [SF-36] were used to assess the quality of life. For the SF-36, eight domain scores [physical functioning [PF], role limitations as a result of physical problems [RP], body pain [BP], general health perceptions [GH], social functioning [SF], role limitations as a result of emotional problems [RE], vitality [VT], mental health [MH]] were calculated. We also calculated summary Physical Component [PCS], Mental Component [MCS] and total scores of QOL. This study included 80 patients treated with HD and PD. The worst score was for RP dimension in both groups, and the best score was for RE in PD patients and BP in HD patients. SF-36 domains of GH, RP, VT and PCS were all significantly higher in the PD patients as compared to the HD patients. The only domain for which significant differences favoured HD patients was BP. [P < 0.05]. This study provided evidence that patients in PD treatment modality were experiencing better quality of life in SF-36 domains of GH, RP, VT, PCS in comparison to HD patients